How will we pay for better small and sick newborn care?

Newborn survival relies on high-quality small and sick newborn care (SSNC), but domestic and donor financing is low, and cost data are limited. We analysed incremental health system improvement costs in Kenya, Malawi, Nigeria and Tanzania using hospital assessments, inpatient data, linking government and NEST360 costs. We calculated per hospital and per baby costs disaggregating by health system building blocks and payers, also benchmarked per hospital costs for Tanzania to national SSNC investment modelled costs for high quality care. Per hospital costs were lower in Malawian district and higher in Tanzanian referral hospitals. Per baby costs were lower in Kenya and higher in Nigeria, influenced by low admissions. Governments main cost was human resources, and data systems and devices were NEST360 cost drivers. Benchmarking measured costs against Tanzania’s investment case suggested investments must be tripled to reach government’s high-quality care norms. More investments are needed for faster progress.

Financial protection is essential for ensuring access to healthcare and improving health outcomes. This research analyses financial hardship indicators and financial protection policy coverage across Sub-Saharan Africa using mixed methods. Across the 44 countries studied, median household out-of-pocket expenditure accounts for 33% of current health expenditure, with Nigeria reporting the highest percentage at 76%. Median proportion of households spending over 10% of their income on health is 5%, with Nigeria ranking third at 16%. Policy analysis of financial protection policies shows that only 61% (27/44) of countries offer no-payment for small and sick newborn care, compared to nearly 73% (32/44) for postnatal newborn care and 68% (30/44) for maternal care. The case study in Nigeria revealed an implementation gap at the state-level. Findings emphasize the need for increased government funding to drive progress towards the Sustainable Development Goals by 2030.

Kenya's Newborn Health Investment Case was developed to mobilize resources in response to persistently high neonatal mortality, which contributes to over half of under-five deaths. With the country off track to meet SDG 3.2, the investment case aimed to provide evidence on the cost, impact, and economic return of scaling up care for small and sick newborns. We applied a standardized five-step approach: policy review, impact modelling, normative costing, ROI analysis, and identification of financing and implementation pathways. We quantified resource needs across various facility levels and included national-level functions such as training and data systems. The analysis offers a compelling case for prioritizing newborn care within Kenya's health strategies. It highlights a replicable model for other LMICs seeking to accelerate progress toward SDG 3.2 through targeted and cost-effective investment in high-impact newborn interventions.